CHEST Guidelines-Response_chest

Response_chest_12 (2)

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In a recent issue of the journal "CHEST," several authors responded to a study on the use of double-lumen endotracheal tubes (DLET) during percutaneous dilatational tracheostomy (PDT). The authors, Maria Vargas, Paolo Pelosi, Robert M. Kacmarek, and Giuseppe Servillo, discussed the feasibility of using the DLET in PDT procedures. They agreed with Dr. Fausto Ferraro and colleagues that while the current DLET design cannot be used for the Fantoni translaryngeal tracheotomy (TLT), future design modifications could potentially improve its utility during TLT, a less frequently used procedure in Italy and other parts of Europe.<br /><br />The primary outcome of the study was to evaluate the feasibility of PDT with DLET, achieving a 100% success rate in PDT completions without having to switch to a conventional endotracheal tube (ET). The study maintained statistical robustness with a power of 0.86 for PaO2 data and 0.99 for plateau airway pressure data, indicating an adequate sample size.<br /><br />The authors also addressed concerns about the possibility of DLET limiting anatomical visibility, asserting that the device, made of transparent polyvinyl chloride, provides clear endoscopic vision from the vocal cords to the carina. They pointed out that while Ferraro et al.'s method increased PaCO2 and decreased PaO2, the DLET did not interfere with ventilation or endoscopic vision. However, they did recommend caution when manipulating the airway, especially in the presence of difficult airways.<br /><br />The authors called for further studies to better define the optimal conditions under which DLET should be used during PDT, highlighting its unique capability to protect the posterior tracheal wall without altering gas exchange or airway pressures.

Keywords

double-lumen endotracheal tubes

percutaneous dilatational tracheostomy

DLET feasibility

Fantoni translaryngeal tracheotomy

endoscopic vision

PaO2 data

plateau airway pressure

anatomical visibility

airway manipulation

tracheal wall protection